# ACTIVISION FIDELITY PSYCHIATRIC MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952008880
- **Authorized official:** KENNY AMANZE CRNP-PMH (PRESIDENT)
- **Authorized official phone:** (301) 907-1199

## Contact information

- **Practice address:** 6475 NEW HAMPSHIRE AVE, HYATTSVILLE, MD 20783-3269
- **Practice address phone:** (301) 907-1199
- **Practice address fax:** (240) 342-3440
- **Mailing address:** 2409 BAIKAL LOOP, UPPER MARLBORO, MD 20774-7051
- **Mailing address phone:** (301) 907-1199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/10/2023
- **Last updated:** 08/10/2026